Two nights ago, I asked David, "Is our marriage okay?" 

While it was a serious question, I didn't mean that our marriage was seriously not okay. Poor David though interpreted it as the latter. 

I've claimed that marriage has been relatively easy, not much different to pre-marriage and living together. The hardest thing has been figuring out what kind of relationship I can have with my mother-in-law, and that's still evolving. 

But lately, I've been a little less happy. I think I've been hyper-aware of falling into routine. Being so busy that when we have free time one day a week, we choose to spend it apart. When we do spend time together, it's in front of the TV. And to be thorough, sex is not as often as I would like. We've never gone less than once a week, but I'd much prefer at least twice a week. 

I think it's the being busy part that is the root cause of it all. But we need to be busy and we should be busy. It's the P90X he does every evening at 8pm. It's the marathon I'm training for, it's the studying I have to do. It's the fishing that he's starting to do regularly. Besides doing P90X with him sometimes, the rest are activities we do separately. 

This is the first time in 3rd year I've felt this way. I didn't even feel this way on surgery. Now I have internal medicine to look forward to with overnight call every 4th night. And looking even further ahead, residency is going to be even more time-demanding. 

I'm glad we addressed it now early in our marriage. We addressed that we just really need to try. Try to spend more time together doing activities and try to have more sex. 

We bought tennis rackets and we love playing tennis together. He agreed to initiate sex more. Now I want to add in bike riding to the picture. 

Poor David had nightmares about my question. He woke up in the middle of the night asking if we're all better and he doesn't even remember asking it. He's so scared of losing me and isn't afraid to show it. I love his commitment. 

Today was my last day on Newborn Nursery. Ob/Gyn and Newborn Nursery have surprisingly not made me itch to have babies. Probably because seeing vaginal lacerations can understandably turn one off from giving birth. And as cute as the babies are on newborn nursery, they are not my baby. Since I have no idea what my baby will look like, I can't imagine actually being in these new moms' shoes. I can't imagine myself ecstatic in a hospital bed chilling and holding my baby. It's just not an image I can easily conjure up in my mind.

Ob/Gyn and Newborn Nursery have taught me a lot about what this whole process will look like and everything I need to do right. I plan on kicking ass at this nurturing thing. I'm really looking forward to breastfeeding and educating my baby - make their body and mind strong.

What I love about David is that he's never been fearful of settling down. We began talking about marriage and kids very early in our relationship. Now 4 years later, we've discussed many, many aspects of raising our future children. I'm not a relationship expert, but I'm sure this is one of the important keys to a relationship. Communication, communication, communication.

Today I passed a picket line in front of the hospital. Reminded me of when I used to picket in undergrad. I even picketed during Lobby Day in my first year of medical school.

What happened?

Medical school has shown me how important it is to my sanity and reality that I be selfish. I used to get excited and put energy into a lot of causes. Now I’m content with just focusing on making my life great.

I consider medical school to have been pretty mild in terms of stress compared to what I expected. While it keeps me well, I have found I can resign to being lazy maybe a little too much. I think med school has also been mildly stressful because I have few major personal problems. Which sounds kind of silly to me considering I’ve been to 4 funerals of close family members since starting medical school, and I got married. One of the reasons I don’t have much personal stress is that I’m shielded from them. My family won’t tell me that someone’s in the hospital or that someone’s depressed because I’m away at medical school. They’re too generous and protective. Even my mom, who is the only person I talk to regularly, doesn’t share with me the darkness in her life. She’s always “fine,” she’ll always be “okay.”

What’s a scary slippery slope for me is that I want it this way. I feel like I know my limits with what I can handle. And I’ve decided I can only handle medical school. I can’t handle the truth of my loved ones struggling. Even when I know partial truths, I don’t think much about it. Maybe my subconscious is not letting me. I allow myself to be this selfish right now, because I tell myself that I’ll be there for them later. I will share more in their lives later.

But what if I’ve already made bad habits? I don’t talk to my favorite cousin, my best friends, or my sister regularly. What if I get content? By avoiding knowing about their struggles, I’m missing out on the good stuff too. I truly want to know how people are doing. I just don’t make it a priority.

So at the picket line today, I walked passed without getting a look at the organization’s name or why they were picketing. They were picketing UC Davis Medical Center – which I feel protective of. I used to fight for the little guy because I was the little guy. But now…I’m going to be a doctor.

I should have found out why they were there. At least just to know. I need to cut down on avoiding things. 

Psychiatry Rotation #3 Part 2

My first site on Psychiatry was at the Sacramento County Mental Health Treatment Center. It's a locked facility. You go there because you legally have to go there.

5150 - danger to self, danger to others, or gravely disabled. 7-day hold.

I had some seriously schizophrenic and bipolar patients. But I was never really afraid of them, even the ones that yelled a lot. I would try half-heartedly to gather information from them, then leave them be. Even when they were yelling, I could just run into the medical student office on the other side of a locked door. No sweat. The culture of SCMHTC wasn't really set up to get to know your patients well, the person they were before they were mentally ill. I just documented if they were acting crazy or saying crazy things. Schizophrenia and bipolar disorder are fascinating, but actually working with these patients is hard for a sane person to do.

What I realized about myself was how drawn I was to the depressed, suicidal patients. They were just regular people who happened to be really sad and having a hard time coping. I would spend way more time talking to them and getting to know them than my schizophrenic or manic patients. That was a good thing to learn about myself.

Psychiatry Rotation #3 Part 1

After finishing my Primary Care rotation, it was perfect that I had Psychiatry right afterwards. I was president of Psychiatry Student Interest Group during my second year of medical school. I was in Klingenstein Child and Adolescent Psychiatry Fellowship. I've gotten to know many important Psychiatry faculty members. If I applied to the Psychiatry residency at UC Davis, I know I'd get in.

The reason for my interest in Psychiatry is complex:
- psychiatric illnesses are super interesting
- psychiatry is a narrow field with limited medications for me to learn and master
- mental health is very important to me especially after my aunt developed depression with psychosis and ultimately committed suicide
- I see a serious need in providing culturally sensitive mental health care to Asians, which is related to my aunt, but actually began with the Virginia Tech shootings where the shooter was Korean American.
- My interviewing skills are excellent (or could be with more training) and patients can open up to me.
- And the most embarrassing reason was a fear of practicing "medicine."

Sigh. I've gotten over this fear throughout third year, which I need to give myself more credit for. What I mean about fear of practicing medicine is that part of me feels inadequate to ever be responsible for another's physical well-being. Responsible for another's health and life? You can see how that's a little scary, right? But along the way during these past 5 rotations, I found confidence. I also found realism. Everyone in medicine feels inadequate sometimes. No one feels awesome about their capabilities all the time. Yet, most of them just don't let settling be an option. They still strive to excel because that's their nature. I'm finally realizing that that's my nature too. I am a gunner. Not compared to my classmates, but compared to the average person. I will be a 26 year-old with an M.D. That's an above average achievement. I also know my limits. I won't be working in the ICU or ED or doing surgery. I'll just stay in the outpatient setting where people are less likely to die.

I'm also scared of doing procedures. But less so than before. I've made 2 surgical incisions. Sutured a knife wound. Drawn lots of blood. Given vaccines, Pap Smears, rectal exams, lidocaine. Delivered 2 babies. Now I need to try giving cortisone shots.

I'm training for a marathon. I'm currently running 4 miles with very little walking. This is the fittest I've ever been in my life at age 25. I look back at my former lifestyle of being sedentary, eating fast food, eating at buffets, and not knowing how to cook. I was at my heaviest in Vegas at 180+ lbs. Now I'm in my high 150's/low 160's, and this weight loss was almost unintentional. I mean it was so gradual and more a product of cultural influence than actual conscious diet and exercise. Losing weight has always been on my mind, but I can only recall a handful of times where I was specifically and regularly tracking my weight loss. My weight loss almost just kind of happened. 

I emphasize that it's really cultural influence that caused me to lead a different type of life than I did in Vegas. Now I associate being sedentary and eating fast food often with low socioeconomic status. Knowing how to cook is hip, and knowing how to cook healthy food is even hipper. I aspire to be a "foodie." That's what college-educated people value. And if half of my medical school classmates are running a half-marathon, then I can do it too. 

My life would not have been nearly as good if I stayed in Vegas. And though it's hypothetical, I'm almost positive about it. I'm glad I got out when I did and I'm glad I'm as fit as I am now. It's not too late for me at 25, it's actually quite early compared to a lot of people. 

This is kind of symbolic of what I think of my maturity at age 25. Because I'm so thoughtful and because I'm so educated and because I'm exposed to lots of different people being in medicine, I really try to live my life well. I have met, known, or learned about people who are ignorant, in denial, close-minded, excessively selfish, hateful, angry, etc. And I strive not to be like them. 

Don't get me wrong, I'm still growing. But I feel like I've outgrown some who are older than me. That's very un-Asian of me to think that way of my elders. Goes to show that I'm Asian American and have adopted Western values in some areas of my life. 

There's this homeless man who lives under a bridge 0.5 miles from my home. I know it's 0.5 miles because I measured the distance for my running trail. He's there about half the time. I think it's where he "lives." Or at least it's where he hangs out a lot.

By the look on his face, I'm assuming he's schizophrenic. That might sound prejudice, but schizophrenia is actually characterized by what we call "flat affect." Meaning they are almost expressionless. They don't even look sad. They just look blank. Hollywood chooses not to include this in their movies about schizophrenics though.

I've smiled at him. And he looks at me with a blank stare. If he's not schizophrenic, then his stare could mean he's in shock that someone's acknowledging him. But I don't think so, I think he's schizophrenic.

I sometimes think about how cold it is during winter and how fucking sucky it would be to sleep outside. I've considered giving him blankets we don't use. I think about giving him some of my water I bring on my run. I've thought about talking to him and asking him what his story is. And today, I even thought about how fucking shitty it would be to not have clean underwear. God, the lives of homeless suck.

I think about things like these every time I go on my run, whether or not he's under the bridge. And yet, I truly don't want to do more than just acknowledge him. If I don't at least acknowledge him, then I would really suck as a human being. I mean, I pass by him frequently, and he's a fellow human with almost nothing, I have to at least let him know I see him. But I don't know when I'll be the person who does something for him, something more than just acknowledgement of his existence.

I've heard of a study where subjects' brains were imaged while being shown photos. When a photo of a homeless person came up, the part of the brain that activated was not the social, emotional center. Their brain activated as if viewing an inanimate object. I could see how that's possible. While we know their human, we treat them like a different kind of human.

I understand on an intelligent level that they could not always have been this way. They were "normal" and cared for at one point in their lives. They've just been so, so unfortunate. So why do I continue to keep a barrier between me and them? Maybe because I'm not ready to be generous right now in my life. I rationalize to myself that I'm six-figures in debt, so I'm technically poorer than them. But that's a lie. I live a very comfortable life while in debt. I can't afford to give to all homeless persons I come across, so I don't give to any.

But what about this homeless man who I see regularly? I don't even see him outside a business begging. I see him where he just kills time, I kind of see him in his home. I don't think I can or want to answer that question yet.

I think about what the hell happened with this man's family that he now appears to be alone. Having such a large family, I know that if I ever got kicked in the ass financially, I would never be homeless. I am very grateful.

Ok I need to blog about this so it is written down and hopefully I'll stick to it.

I need to stop talking poorly about David's parents...at least in front of David.

I forget how hurtful it can be even if the things I'm saying are true. They are his parents, and even if he holds the same opinion about them as I do, it is okay for him to speak as such and it is not okay for me to.

It's not that I plan to never speak my opinions of them again. But I feel I'm doing it frequently and achieving no purpose. I'm not even trying to achieve a purpose except to just remind him. And I know I don't really need to remind him. He knows. I think I want to remind him just in case though because after what happened with his mom last time we visited, I want him to fully understand that I'm so turned off by her that we are no way staying with them again. I don't even want to have a discussion about it. So I think I remind him just to make sure we don't have that discussion.

I will try to stop now. He definitely understands. She was ridiculously out of line and must learn that she cannot keep people close to her while behaving that way. I don't think there will be much discussion. Also, this discussion won't even be an issue for an unknown amount of time. I have no idea when I'll be visiting so Cal again.

David has vocalized to me that it sucks to hear all the things I have to say about his mom though he knows they're true. And I completely empathize with him. I recognized awhile ago that even though I held poor opinions of my dad, I very much disliked it when others voiced those same opinions to me. The daughter in me wants to say "hey, that's my dad!" If I still feel that way about my dad who I barely ever talk to or see, then David must feel it a lot stronger about his parents who he's relatively close to. I don't know how they raised such a sweet boy. Oops. Supposed to be stopping. Ok that was it.

This reminds me of a picture from childhood that still causes struggle in me. A few years ago, I was looking at my mom's old photos. There was a picture of me at about 2 years old being held by my dad. I remember thinking, "wow, I was so tiny. My dad used to be able to hold me. And now I'm stronger than him." He looked like he loved me in that picture, like he never wanted to hurt me. I know that's still true. Mainly all the hurt he caused me was because he hurt my mom. He was selfish and ignored the fact that it was hurting his relationship with his daughters. Ugh, I'm so conflicted about him.

Last Day of Outpatient Pediatrics

Today was the end of my 3 short weeks on outpatient pediatrics. I am very grateful to have been assigned to my site.

I initially requested 2 Davis sites and acted very resentfully when I didn't get them. But now I realize I was quite fortunate.

I worked 1-on-1 with a UC Davis solely outpatient pediatrician. I gained a lot from the repetition of working with him. I got to really learn how he provides primary care. He does it compassionately, efficiently, and skillfully. I would love to have him as my future children's pediatrician. It was also great to be with a university pediatrician with a larger proportion of medically complex kids than a community pediatrician.

He was also an excellent and proactive teacher. He asked me what my goals were regularly and provided me with feedback often. He encouraged my practicing physical exam skills. Now that I'm starting to feel comfortable with kids' physical exams, I bet my adult physical exams have improved as well.

I am proud and humbled by my performance on this rotation.

The things I am proud of are: detecting decreased breath sounds on a child's left lung and he was subsequently diagnosed with pneumonia, splinting a broken pinky all by myself, writing "superb" notes, starting to finally know what ear drums look like, and just being great with kids.

I am humbled by my presentation skills. I was not very fluent and confident in my oral presentations. I know I paused a lot because that was my natural response to someone typing what I was saying. But he specifically told me not to pause, and I continued to do it. Don't know why that was so hard for me to get over. Presentations were never my weakness, I feel I'm at least average. Nevertheless, I'm humbled that I didn't do something with ease.

During pediatric nephrology, I was also humbled when I sucked at my first oral presentation of a NICU baby. I agreed and I am proud that I didn't let it get to me. I take constructive criticism better than I give myself credit for. Probably because so far it's been helpful and true. What's funny though is when she actually used the word "sucked" 5 days later, but in the context of my significant improvement. I laughed with her in agreement.

Rotation #2 Primary Care

So my 2nd rotation in 3rd year was Primary Care. After leaving that rotation, I was 80% sure I was going into Primary Care.

I don't have any specific good stories or memories to share about the rotation, but just a general feeling about certain principles and qualities of primary care.

- I like taking care of chronic illnesses. I can understand why some people dread the idea of managing diabetes, high blood pressure, and high cholesterol all day long. But that actually appeals to me. One reason is that I'm familiar with managing those conditions through my work at Paul Hom Asian Clinic. Secondly, and also, related to Paul Hom Asian Clinic, I've personally witnessed what happens when you don't have those things managed: end-organ damage. I'd be happy to help in preventing end-organ damage.

- I like continuity of care. I love it when preceptors can tell me their patients' life stories. I'm so impressed with their memory and also just love knowing people's life stories. How lucky am I that I will have a career where I have meaningful relationships with so many people.

- I like being the front line of mental health care. Everyone has stress in their lives. And when that stress becomes pathological, people go to their primary care doctor first. This is especially true for Asians. That was true for my aunt; I don't think she ever trusted the psychiatrists.

- Low back pain sucks. I don't look forward to dealing with people in chronic pain. I don't fully connect with them at this point in my training. I'm struggling having empathy for them.

- I love working with children. They are so cute and make me smile. I smile all day during pediatrics. One big reason I'm not going into pediatrics though is the pay (I know, I'm struggling with my materialism). Another is the first bullet point above.

- Primary care doctors are the most important educators of all doctors because they are the primary educators. And what would I have been if I didn't get into medical school? A teacher!

- Not knowing the answers to everything makes me uncomfortable. But I recognize that I'm only a 3rd year medical student, and I already know A LOT more than when I started. So I will continue to learn A LOT more through residency.

At this moment, I am 90-95% sure I am going into Family Medicine. The more I think about it, the more I can't imagine myself in anything else. I can't believe I'll have my MD in 15 short months. Wow. What a trip.